From Silos to Systems: Assessing Illinois' Public Health System

Transcription

1 The Illinois Public Health Futures Institute September 2004 Chicago, Illinois From Silos to Systems: Assessing Illinois' Public Health System Professional Associations Tribal Health Community Health Centers Corrections Public Health Institutes Insurance Voluntary Health Organizations Philanthropy State Agencies EMS Parks Faith Organizations State & Local Boards of Health Drug Treatment Laboratory Facilities Health Department Fire Hospitals Doctors Arts Organizations Economic Development Civic Groups Community-based Organizations Academic Institutions Mental Health Environmental Health Elected Officials Law Enforcement Nursing Homes Home Health Employers Transportation The assessment process and report were made possible by funding through the Illinois Department of Public Health by the Public Health Preparedness and Response for Bioterrorism Cooperative Agreement with the U.S. Centers for Disease Control and Prevention.

2 Acknowledgments I would like to gratefully acknowledge the assistance and support of the following organizations and individuals. Without their help, we could not have completed this assessment: All the Silos to System retreat participants who gave their time and perspectives to help make the assessment a success Eric E. Whitaker, M.D., M.P.H., director, Illinois Department of Public Health and Carol Adams, Ph.D., secretary, Illinois Department of Human Services, who served as co-conveners of the retreat Catherine M. Stokes, deputy director, Office of Preparedness and Response, and Donald Kauerauf, chief, Division of Disaster Planning and Readiness Advisory Committee members Connie Brooks, R.N., director, Office of Community Health and Prevention, IDHS; Quin Golden, chief of staff, IDPH; Patti Kimmel, chief, Division of Health Policy, IDPH; Georgeen Polyak, Ph.D., director, Oak Park Department of Public Health; Tracey Printen, research associate, Illinois State Medical Society; and Adrienne White, vice president of health initiatives and advocacy, American Cancer Society, Illinois Division Retreat facilitators Joyce Hollingsworth, Mary Morten, Siobhan Pitchford, Cinda Rierson and Rhadika Sharma Recorders Heidi Britton, Diana Derige, Eowyn Powell, Valerie Webb and Regina Whitmore Technical observers Joyce D.K. Essien, M.D., M.B.A., director, Center for Public Health Practice, Rollins School of Medicine, Emory University, Atlanta, GA; Jeffrey Todd, M.S., C.A.E., administrator, Stephenson County Health Department Technical observer and retreat keynoter Paul K. Halverson, Dr.P.H., professor and chair, Department of Health Policy and Management, University of Arkansas for Medical Sciences, College of Public Health, Little Rock, AR Technical observer and retreat moderator Richard H. Sewell, M.P.H., president, Sewell and Associates, and clinical assistant professor, Health Policy and Administration, University of Illinois at Chicago School of Public Health Technical observer and consultant Laura Landrum, M.U.P.P., consultant on performance standards, Association of State and Territorial Health Officials, and special projects director, Illinois Public Health Futures Institute Project manager Karen Singer, consultant to the Illinois Public Health Futures Institute Administrative assistant Eric Grawe Elissa J. Bassler Executive Director, Illinois Public Health Futures Institute From Silos to Systems: Assessing Illinois' Public Health System,

3 Table of Contents Acknowledgements 1 Introduction Background.. 3 The National Public Health Performance Standards Program 4 From Silos to Systems: Assessing Illinois Public Health System. 5 Assessment Results Interpreting the Results 8 Summary Scores. 8 EPHS 1: Monitor Health Status to Identify Health Problems.12 EPHS 2: Diagnose and Investigate Health Problems and Health Hazards...14 EPHS 3: Inform, Educate, and Empower People about Health Issues. 16 EPHS 4: Mobilize Partnerships to Identify and Solve Health Problems 19 EPHS 5: Develop Policies and Plans that Support Individual and Statewide Health Efforts.21 EPHS 6: Enforce Laws and Regulations that Protect Health and Ensure Safety.24 EPHS 7: Link People to Needed Personal Health Services and Assure the Provision of Health Care when Otherwise Unavailable..27 EPHS 8: Assure a Competent Public and Personal Health Care Workforce.30 EPHS 9: Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services 33 EPHS 10: Research for New Insights and Innovative Solutions to Health Problems 36 Conclusion and Next Steps 40 Appendices Appendix A. State Public Health System Performance Assessment: Methodology 42 Appendix B. CDC Report 46 Summary Scores Summary Scores at the Indicator Level Summary of Performance on Model Standards System Performance and Agency Contribution Summary Question Responses Appendix C. Participant Organizations 76 Appendix D. Retreat Agenda 78 From Silos to Systems: Assessing Illinois' Public Health System,

4 From Silos to Systems: Assessing Illinois' Public Health System,

5 INTRODUCTION I. Background Preventing illness and improving health are constant challenges. The ability to meet these challenges rests on the capacity and performance of public health systems. The Illinois Public Health Futures Institute (IPHFI) was formed in 1997 to strategically plan for public health system development in Illinois. IPHFI works through partnerships to promote prevention and improve public health systems to maximize health and quality of life in Illinois. This collaboration between public and private health-related organizations effectively harnesses the energy of many different entities in improving the health of Illinois residents and their communities. In addition to state and local public health agencies, the partnership includes health care, business, faith, insurance, social service, philanthropic, government, academic, labor, consumer and advocacy organizations. Since the publication of its Illinois Plan for Public Health Systems Change in 2000, IPHFI has emphasized the importance of developing the public health infrastructure through performance monitoring and systems development. The roles of assessment and planning at the state and local levels in strengthening and focusing health improvement activities are essential in this effort. IPHFI seeks to engage partners in understanding their role in the public health system and in taking collective action to make improvements; such collective action is critical to building the public health system and is a key aspect of strengthening the public health infrastructure. This focus on infrastructure and systems development, along with a long-term policy goal of implementing state health improvement planning in Illinois, prompted IPHFI to collaborate with the Illinois departments of Public Health (IDPH) and Human Services (IDHS) to implement the state-level National Public Health Performance Standards (NPHPS) assessment in Illinois. This assessment was funded through the Illinois Department of Public Health by the Public Health Preparedness and Response for Bioterrorism Cooperative Agreement with the U.S. Centers for Disease Control and Prevention (CDC). The assessment is encouraged by the CDC preparedness program as a means of measuring the strength of the overall public health infrastructure within which emergency preparedness occurs. These performance standards are intended to guide the development of stronger public health systems capable of improving the well-being of populations. In Illinois, planning and quality improvement initiatives are already underway, and these assessment results provide important baselines to inform those efforts. These activities include internal IDPH strategic planning focusing on community engagement and strengthening the public health infrastructure and the implementation of the newly enacted State Health Improvement Plan (SHIP) legislation. This legislation requires the state to produce a health improvement plan focused on prevention every four years; the SHIP includes provisions for identifying public health system improvement priorities and using public health system assessments like the National Public Health Performance Standards. Illinois is the sixth state to conduct the state-level National Public Health Performance Standards assessment. Future reassessments using the NPHPS tool in conjunction with SHIP development will help gauge Illinois progress in achieving and maintaining optimal public health system performance. From Silos to Systems: Assessing Illinois' Public Health System,

6 II. The National Public Health Performance Standards Program The National Public Health Performance Standards Program (NPHPSP) began in 1998 as a partnership between the U.S. Centers for Disease Control and Prevention and five national public health organizations: the American Public Health Association (APHA), the Association of Schools of Public Health (ASPH), the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO) and the Public Health Foundation (PHF). Recently, the National Network of Public Health Institutes has joined the NPHPSP partnership to promote implementation through state public health institutes like IPHFI. The NPHPSP was initiated to improve the quality of public health practice and the performance of public health systems by providing performance standards for public health systems and encouraging their widespread use; engaging and leveraging national, state and local partnerships to build a stronger foundation for public health preparedness; promoting continuous quality improvement of public health systems; and strengthening the science base for public health practice improvement. There are four concepts that have helped to frame the NPHPSP: 1. The standards are designed around the 10 Essential Public Health Services (EPHS). The use of the essential services assures that the standards fully cover the scope of public health action needed at state and community levels. 10 Essential Public Health Services 2. The standards focus on the overall public health 1. Monitor health status to identify system, rather than a single organization. A public and solve community health problems. health system includes all public, private and voluntary 2. Diagnose and investigate health entities that contribute to public health activities within a problems and health hazards. given area. This assures that the contributions of all 3. Inform, educate and empower people about health issues. entities are recognized in assessing the provision of 4. Mobilize community partnerships essential public health services. and action to identify and solve health problems. 5. Develop policies and plans that support individual and community 3. The standards describe an optimal level of health efforts. performance rather than provide minimum 6. Enforce laws and regulations that expectations. This assures that the standards can be protect health and ensure safety. 7. Link people to needed personal used for continuous quality improvement. The health services and ensure the standards can stimulate greater accomplishment and provision of health care when provide a level to which all public health systems can otherwise unavailable. aspire to achieve. 8. Assure a competent public and personal health care workforce. 9. Evaluate effectiveness, accessibility and quality of 4. The standards are intended to support a process of personal and population-based quality improvement. System partners should use the health services. 10. Research for new insights and assessment process and the performance standards innovative solutions to health results as a guide for learning about public health problems. activities throughout the system and for determining how to make improvements. From Silos to Systems: Assessing Illinois' Public Health System,

7 The NPHPSP includes three instruments to assess performance of the overall public health system: a state, local and governance instrument. Each instrument underwent extensive fieldtesting and validation studies. The state performance standards instrument received approval from the United States Office of Management and Budget for nationwide voluntary use in July Within the state instrument, the same four indicators are used to describe major activities or practice areas of each essential service. Each indicator is illustrated by model standards that describe aspects of optimally performing public health systems. Each model standard is followed by assessment questions that serve as measures of performance of the public health system. These four indicators and the summary of the model standard associated with them are as follows: Planning and implementation. The state public health system (SPHS) works collaboratively to plan and design programs and to implement key activities to accomplish the essential service. Technical assistance and support. The SPHS provides assistance, capacity building and resources to local public health systems and to other state partners in the effort to implement the essential service. Evaluation and quality improvement. The SPHS reviews its activities to accomplish the EPHS on a predetermined, periodic basis and uses the results from these reviews to improve the quality and outcome of its efforts. Resources. The SPHS effectively invests, manages and utilizes its human, information, technology and financial resources to accomplish the EPHS. III. From Silos to Systems: Assessing Illinois Public Health System On June 14 and 15, 2004, IPHFI, IDPH and IDHS convened From Silos to Systems: Assessing Illinois Public Health System to discuss and rate the Illinois public health system s performance using the National Public Health Performance Standards. The conference drew 76 public health system partners from the public, private and voluntary sectors. Of these, 40 percent represented state government and 60 percent were from local public health, private and voluntary sector organizations. For a list of participants and their affiliations, see Appendix C. The diverse set of public health systems partners participating in the assessment are depicted in the pie chart on the following page. From Silos to Systems: Assessing Illinois' Public Health System,

8 Diversity of Participation Associations of Organizations 3% Philanthropy 1% Insurance 3% Business 3% Professional Assoc. 6% CBOs 3% Minority Health Orgs. 6% IDPH 31% Academic Institutions 8% Local Health Departments 9% Health Issue Groups 10% Boards of Health 5% IDHS 6% Other State Agencies 6% After orientation to the National Public Health Performance Standards and the assessment process, participants were divided into five working groups that reviewed, discussed and rated indicators in each of two essential health services categories over the two-day meeting. Facilitators, recorders and technical observers were assigned to each group to assure progress and to capture the essence of the work group discussions. The groups were reconvened at the end of the conference to reflect on the experience and to share observations. For a more detailed description of the methodology, refer to Appendix A. Following the conference, the rating for each measure was submitted to the U.S. Centers for Disease Control and Prevention, which analyzed the data and provided summary performance scores for each essential service, model standard and key activity area. Selections from these data are presented in the body of this report; the full CDC report is included in Appendix B. From Silos to Systems: Assessing Illinois' Public Health System,

9 CDC uses a scoring algorithm to assign points for each measure and the following scale to reflect the extent to which the model standards are being met: Fully met: 80 points Substantially met: points Partially met: Not met: 25 points This report, which describes the results of the Illinois public health system assessment, includes the following: I. Overall summary of Illinois assessment results Summary chart of the 10 essential services A summary chart of the 10 essential services across all four indicators Summary performance on model standards pie chart Common themes raised in the essential services discussions II. Each essential service The essential service and activities included The model standards associated with the EPHS Performance score for the EPHS by indicator System performance on the model standards and IDPH contribution 1) How much of the SPHS model standard is achieved by the state public health system collectively? 2) What percentage of the above answer is directly contributed by the public health agency (Illinois Department of Public Health)? Three highest scoring and three lowest scoring measures in the EPHS Participant observations on the EPHS III. Conclusion and next steps IV. Appendices Appendix A. Methodology, From Silos to Systems: Assessing Illinois Public Health Systems Appendix B. CDC Charts, Graphs and Tables Appendix C. Participants, From Silos to Systems: Assessing Illinois Public Health Systems Appendix D. Retreat Agenda, From Silos to Systems: Assessing Illinois Public Health Systems From Silos to Systems: Assessing Illinois' Public Health System,

10 Assessment Results Interpreting the Results In general, Illinois scores are fairly low on this assessment. The average score across all measures and indicators is 32, meaning that, overall, the Illinois public health system is partially meeting the National Public Health Performance Standards (the range for partially met is 26-60). Among the seven states for which NPHPS data are currently available, the average overall score is 44. Comparing Illinois to other states must be done cautiously because each state approached the process very differently. This is a self-assessment activity, so who participates, what assumptions underlie the effort, and the context can and does have an impact on the results. Several states did not engage the breadth of system partners that participated in Illinois; in fact, in some states, the assessment was conducted only with health agency staff and no external system partners participated. The qualitative data collected at the Silos to Systems assessment retreat lead to an inescapable conclusion: while there is more or less activity going on related to each standard and measure (sometimes quite a lot of effort), the work is going on in silos (individual categorical efforts), not systems. Thus, in the context of a systems assessment, the state s performance fell short of the substantially met or met ratings. This theme emerged as each of the 10 essential services were considered, as well as during the final plenary meeting in which the group sought to synthesize the work of the previous day and a half. Further, it was clear from the energy and passion that infused the discussions that, far from being discouraged by the low scores, the participants saw them as a challenge to themselves and the rest of the system: This is an opportunity to improve; let s grab it. Thus, the results presented here should be regarded as a baseline, and a call to action. The real story of this assessment will be in how the stakeholders in the Illinois public health system use these results to inform quality improvement activities and in how Illinois scores on follow-up assessments. Summary Scores Overall, the Illinois public health system assessment resulted in an average score of 32. Essential public health service 2, Diagnose and Investigate Health Problems and Health Hazards, scored well above the other essential public health services. The remaining nine essential services were rated relatively low in the Illinois performance assessment process. From Silos to Systems: Assessing Illinois' Public Health System,

11 Essential Public Health Services Summary Score EPHS Summary Scores EPHS 2: Diagnose and Investigate Health Problems and Health Hazards was ranked the highest among the 10 essential public health services and was the only service ranked substantially met. EPHS 5: Develop Policies and Plans that Support Individual and Statewide Health Efforts was ranked the lowest among the 10 essential public health services and was ranked not met. One of the remaining essential public health services was ranked not met, while seven were rated as partially met. Summary Scores for Key Indicators Across Essential Services The use of the same four indicators in each EPHS enables an examination of patterns in these four key areas of state system activity. The weakest indicators across all 10 essential public health services were Indicators 2, Technical Assistance and Support, and 3, Evaluation and Quality Improvement. Average Scores for State Indicators Across Essential Services Planning and Implementation (1) Technical Assistance and Support (2) Indicator 1: Planning and Implementation received the highest average score across the 10 essential public health services. Evaluation and Quality Improvement (3) Resources (4) Indicator 3: Evaluation and Quality Improvement received the lowest average score across the 10 essential public health services From Silos to Systems: Assessing Illinois' Public Health System,

12 Distribution of Performance Ratings for All 40 Model Standards 5% When assessed in Illinois, 40% 40 percent of all model standards were not met. 55% 55 percent were partially met. 5 percent were substantially met. Not met: score of 25 or less Partially met: Score between 26 and 59 Substantially met: Score between 60 and 80 None were fully met. Common Qualitative Themes Throughout the discussion in each of the essential service breakout groups, common themes emerged: Uncoordinated efforts do not constitute public health system performance, regardless of the quantity of ongoing activities. Many organizations engage in public health action and are committed to improving their performance as part of the Illinois public health system. Lack of adequate capacity in data collection, analysis and interpretation limits performance across the essential services. Provision of technical assistance and support throughout the state is uneven and uncoordinated. Poor performance in evaluating public health programs and systems activities threatens the relevance and appropriateness of public health actions to improve health. Adequate resources to support high quality public health system performance remain an issue. From Silos to Systems: Assessing Illinois' Public Health System,

13 Essential Public Health Service 1 Monitor Health Status to Identify Health Problems This service includes -- Assessment of statewide health status and its determinants, including the identification of health threats and the determination of health service needs; Attention to the vital statistics and health status of specific groups that are at higher risk for health threats than the general population; Identification of community assets and resources, which support the SPHS in promoting health and improving quality of life; Utilization of technology and other methods to interpret and communicate health information to diverse audiences in different sectors; and Collaboration in integrating and managing public health related information systems; Model Standards Summary 1.1 Planning and Implementation Measure, analyze and report on the health status of the state by -- Collecting health data and collaborating with data reporting entities Producing a state health profile Tracking and compiling data for surveillance Managing a uniform data set from diverse sources Protecting confidentiality 1.2 Technical Assistance and Support Assist locals and other state entities by -- Offering training in data interpretation Helping others to develop data systems and prepare and publish health data Providing uniform set of health indicators Communicating the availability of state technical assistance 1.3 Evaluation and Quality Improvement Periodically review and improve monitoring activities by -- Determining sufficiency and relevance of health monitoring efforts Using results of review for quality improvement Improving the state health profile, in collaboration with users 1.4 Resources Manage resources to monitor health status by -- Allocating resources to areas of highest need and seeking new resources Leveraging system-wide resources Using state-of-the-art computer resources Using workforce expertise in collecting and analyzing data and managing data systems Illinois Summary Performance Scores for EPHS 1 Overall, Illinois scored 28 (partially met) on EPHS 1. This service is ranked fifth among the 10 essential services. Performance Score by Model Standard for EPHS 1 >80 points Fully Met 1.1 Planning and Implementation: Partially met points Substantially Met 1.2 Technical Assistance and Support: Not met points Partially Met 1.3 Evaluation and Quality Improvement: Not met 1.4 Resources: Partially met <25 points Not Met Model Standard From Silos to Systems: Assessing Illinois' Public Health System,

14 SPHS Performance and IDPH Contribution Toward EPHS 1 The Illinois SPHS collectively achieves the following: percent of the Planning and Implementation model standard with 75 percent of the system s 75 effort contributed by IDPH percent of the Technical Assistance and 50 Support model standard with 75 percent of the system s effort contributed by IDPH percent of the Evaluation and Quality Improvement model standard with 75 percent of the system s effort contributed by IDPH percent of the Resources model standard Model Stan dar d with 75 percent of the system s effort contributed Collective System Performance IDPH Contribution by IDPH Key Measures The three highest scoring measures for EPHS 1 The state public health system -- Enforces laws and uses protocols to protect personal health information and other data with personal identifiers; Uses current electronic technology to monitor statewide health status; and Develops surveillance programs to measure the state s health status. The three lowest scoring measures for EPHS 1 The state public health system -- Organizes health-related data into a state health profile; Assists local public health systems and other state partners in developing health-related data information systems; and Solicits feedback from partners regarding development and distribution of the state health profile. Participant Observations There is a need for a comprehensive state health profile that is current and accessible to all system partners. Data systems are characterized by limited accessibility for all system participants and lack of sharing and coordination. Census data do not provide a full and accurate set of population data, especially with respect to racial and ethnic minority populations. Reporting of health events in Illinois is often fragmented, inconsistent and incomplete. There needs to be a better infrastructure for data collection, analysis and/or interpretation at the local level. From Silos to Systems: Assessing Illinois' Public Health System,

15 Essential Public Health Service 2 Diagnose and Investigate Health Problems and Health Hazards This service includes -- Epidemiologic investigation of disease outbreaks and patterns of infectious and chronic diseases, injuries, and other adverse health conditions; Population-based screening, case finding, investigation and the scientific analysis of health problems; and Rapid screening, high volume testing, and active infectious disease epidemiologic investigations. Model Standards Summary 2.1 Planning and Implementation Identify and respond to public health threats (including infectious disease, chronic disease, injury, disasters, and environmental exposures) by -- Operating state surveillance system(s) Operating systems to receive and transmit reportable disease data Collaborating with laboratories to assure capacity to analyze specimens Developing investigation and response plans 2.2 Technical Assistance and Support Assist locals and other state entities by -- Helping with epidemiologic analysis Providing laboratory assistance Communicating information about public health threats Sending trained personnel to local communities to assist in investigation and response to threats 2.3 Evaluation and Quality Improvement Periodically review and improve diagnosis and investigation activities by -- Reviewing the effectiveness of state surveillance systems Reviewing and testing the effectiveness of threat investigation and response plans Using results of review for quality improvement 2.4 Resources Manage resources to diagnose and investigate threats by -- Allocating resources to areas of highest need and seeking new resources Leveraging system-wide resources Using laboratories capable of screening, testing and identifying disease pathogens Utilizing expertise in epidemiology Using multidisciplinary teams for investigations Illinois Summary Performance Score for EPHS 2 Overall, Illinois scored 64 (substantially met) on EPHS 2. This service is ranked first among the 10 essential services. Performance Score by Model Standards for EPHS >80 points Fully Met 2.1 Planning and Implementation: Partially met points 2.2 Technical Assistance and Support: Substantially met Substantially Met Evaluation and Quality Improvement: Partially met points Partially Met 2.4 Resources: Substantially met 25 <25 points Not Met Model Standard From Silos to Systems: Assessing Illinois' Public Health System,

16 SPHS Performance and IDPH Contribution Toward EPHS 2 The Illinois SPHS collectively achieves the following: percent of the Planning and Implementation model standard with 75 percent of the system s effort contributed by IDPH percent of the Technical Assistance and Support model standard with 75 percent of the system s effort contributed by IDPH percent of the Evaluation and Quality Improvement model standard with 75 percent of the system s effort contributed by IDPH percent of the Resources model standard with 75 percent of the system s effort Model Stan dar d contributed by IDPH Collective System Performance IDPH Contribution Key Measures The three highest scoring measures for EPHS 2 The state public health system -- Uses laboratory facilities with capacity to identify diseases required by the state or included in the National Notifiable Diseases Surveillance System; Provides trained on-site personnel to assist communities with investigations; and Uses in-state laboratories to investigate key diseases and conditions. The three lowest scoring measures for EPHS 2 The state public health system -- Provides screening tests in response to exposures to health hazards; Reviews information to improve surveillance system responsiveness to health threats; and Operates a reporting system to identify potential threats to public health. Participant Observations Illinois has not addressed Healthy People 2010 leading health indicators. Chronic disease epidemiology is limited in areas where Illinois does not operate disease registries. Environmental epidemiology is not adequate in Illinois. Environmental health risks are not well documented, and laboratory capacity for environmental specimens is a weakness. For environmental hazard surveillance programs, data are not used to take regulatory action. In general, surveillance programs need to be redesigned for prevention and preparation for future events. Potential threats are not identified. Roles and responsibilities in responding to public health threats are not well defined outside official public health departments. From Silos to Systems: Assessing Illinois' Public Health System,

17 Essential Public Health Service 3 Inform, Educate, and Empower People about Health Issues This service includes -- Health information, health education, and health promotion activities designed to reduce health risk and promote better health; Health communication plans and activities such as media advocacy and social marketing; Accessible health information and educational resources; and Health education and promotion program partnerships with schools, faith communities, work sites, personal care providers and others to implement and reinforce health promotion programs and messages. Model Standards Summary 3.1 Planning and Implementation Conduct communication and health education / promotion initiatives by -- Offering programs to meet health needs and respond to emergent public health issues Designing programs in collaboration with target populations Using culturally and linguistically appropriate messages Delivering health campaigns through appropriate media 3.2 Technical Assistance and Support Assist locals and other state entities by -- Enabling partners to develop strategies that meet their needs Assisting in development of local/other resources Assisting in development of effective strategies for target populations Providing consultation and training 3.3 Evaluation and Quality Improvement Periodically review and improve activities to inform, educate and empower people by -- Reviewing effectiveness of health communication and education/promotion activities Designing reviews of interventions with active participation of populations served Using results of review for quality improvement 3.4 Resources Manage resources to inform, educate and empower people by -- Allocating resources to areas of highest need and seeking new resources Leveraging system-wide resources Providing resources necessary to plan, implement and evaluate interventions Using expertise and skill sets in communication and health education and promotion Illinois Summary Performance Score for EPHS 3 Overall, Illinois scored 27 (partially met) on EPHS 3. This service is ranked sixth among the 10 essential services. Performance Score by Model Standard for EPHS Planning and Implementation: Partially met >80 points: Fully Met points: Substantially Met 3.2 Technical Assistance and Support: Not met 3.3 Evaluation and Quality Improvement: Partially met points: Partially Met 3.4 Resources: Not met <25 points: Not Met Model Standard From Silos to Systems: Assessing Illinois' Public Health System,

18 SPHS Performance and IDPH Contribution Toward EPHS 3 The Illinois SPHS collectively achieves the following: percent of the Planning and Implementation model standard with 75 percent of the system s effort contributed by IDPH percent of the Technical Assistance and Support model standard with 50 percent of the 50 system s effort contributed by IDPH percent of the Evaluation and Quality 25 Improvement model standard with 75 percent of the system s effort contributed by IDPH percent of the Resources model standard with 75 percent of the system s effort contributed Model Stan dar d by IDPH Collective System Performance IDPH Contribution Key Measures The three highest scoring measures for EPHS 3 The state public health system -- Uses multiple channels to provide current health information, education and promotion services; Uses professional expertise for effective health communication; and Periodically reviews health communication and health education promotion interventions. Three lowest scoring measures for EPHS 3 The state public health system -- Delivers culturally and linguistically appropriate health education and health promotion materials and activities; Involves the population served in the design and implementation of reviews; and Shares system-wide resources to implement health communication, and health education and promotion services. Participant Observations Overall, the system performs better in planning and implementation for emerging issues (e.g., bioterrorism) than for specific longstanding issues, such as environmental health. While some areas are rich with theoretical and evidence-based frameworks (e.g., tobacco), others (e.g., obesity) employ the best thinking. The lack of a state health improvement plan influenced the ratings of this EPHS, as standards call for a strong connection between health promotion program design and state health improvement objectives. Some pieces of a public health system exist for this EPHS, but there is no system coordination and no overall evaluation of the system is conducted. Technical assistance and support are not available statewide. Seeking new resources to support this EPHS is currently a low priority for system partners. From Silos to Systems: Assessing Illinois' Public Health System,

19 Essential Public Health Service 4 Mobilize Partnerships to Identify and Solve Health Problems This service includes -- The organization and leadership to convene, facilitate, and collaborate with statewide partners (including those not typically considered to be health-related) to identify public health priorities and create effective solutions to solve state and local health problems; The building of a statewide partnership to collaborate in the performance of public health functions and essential services in an effort to utilize the full range of available human and material resources to improve the state s health status; and Assistance to partners and communities to organize and undertake actions to improve the health of the state s communities. Model Standards Summary 4.1 Planning and Implementation Conduct community engagement, constituency development and partnership mobilization by -- Engaging public health constituencies around specific health issues Organizing partnerships to share responsibilities for public health Communicating regularly with constituencies about priority health issues 4.2 Technical Assistance and Support Assist locals and other state entities by -- Providing consultation on constituency development and partnership facilitation Providing training to enhance skills in community mobilization 4.3 Evaluation and Quality Improvement Periodically review and improve partnership mobilization activities by -- Reviewing constituency and partnership activities and using results to improve processes Reviewing the commitment of state policy leaders and others in partnership efforts 4.4 Resources Manage resources to mobilize partnerships by -- Allocating resources to areas of highest need and seeking new resources Leveraging system-wide resources Supporting partnership growth Using collaboration expertise to organize and mobilize partners Illinois Summary Performance Scores for EPHS 4 Overall, Illinois scored 25 (not met) on EPHS 4. This service is ranked ninth among the 10 essential services. Performance Score by Model Standard for EPHS 4 80 >80 points Fully Met points Substantially Met 4.1 Planning and Implementation: Partially met 4.2 Technical Assistance and Support: Not met points Partially Met 4.3 Evaluation and Quality Improvement: Not met 4.4 Resources: Not met 8 <25 points Not Met Model Standard From Silos to Systems: Assessing Illinois' Public Health System,

20 SPHS Performance and IDPH Contribution Toward EPHS 4 The Illinois SPHS collectively achieves the following: percent of the Planning and Implementation model standard with 50 percent of the system s effort contributed by IDPH percent of the Technical Assistance and Support model standard with 50 percent of the 50 system s effort contributed by IDPH percent of the Evaluation and Quality 25 Improvement model standard with 50 percent of the system s effort contributed by IDPH percent of the Resources model standard with 25 percent of the system s effort contributed Model Stan dar d by IDPH Collective System Performance IDPH Contribution Key Measures The three highest scoring measures for EPHS 4 The state public health system -- Briefs state and local policy leaders using established procedures and timelines; Builds constituencies to address health issues; and Builds partnerships to identify and solve health problems. The three lowest scoring measures for EPHS 4 The state public health system -- Shares system-wide resources to develop constituencies and mobilize partnerships; Utilizes workforce expertise in collaborative group processes necessary to assist partners to organize and act in the interest of public health; and Reviews constituency-building and partnership facilitation activities. Participant Observations There are state and local partnerships that deal with a single issue but not many that deal with a broad spectrum of health issues. The partnerships are not geographically dispersed and almost always under-funded. The business community feels pushed out of public health. Business has a big stake in solving these problems and more involvement is needed. Effective technical assistance and support in partnership development are needed in Illinois. Evaluation is needed on a regular, predetermined basis. Financial and human resources for partnership development are inadequate. From Silos to Systems: Assessing Illinois' Public Health System,

21 Essential Public Health Service 5 Develop Policies and Plans that Support Individual and Statewide Health Efforts This service includes -- Systematic health planning that relies on appropriate data, develops and tracks measurable health objectives, and establishes strategies and actions to guide community health improvement at the state and local levels; Development of legislation, codes, rules, regulations, ordinances and other policies to enable performance of the essential public health services, supporting individual, community, and state health efforts; and The democratic process of dialogue and debate among groups affected by the proposed health plans and policies prior to adoption of such plans or policies. Model Standards Summary 5.1 Planning and Implementation Implement comprehensive health improvement planning and policy development by -- Convening partners and facilitating a planning process Establishing a state health improvement plan Advocating for needed health policy changes 5.2 Technical Assistance and Support Assist locals and other state entities by -- Providing assistance, training and support in community health improvement planning Linking state and local planning Assisting in local health policy development 5.3 Evaluation and Quality Improvement Periodically review and improve planning and policy development activities by -- Reviewing progress in achieving health objectives Reviewing impact of health policies Using review results to improve plans and policies 5.4 Resources Manage resources to develop policies and plans by -- Allocating resources to areas of highest need and seeking new resources Leveraging system-wide resources Using expertise in planning, policy analysis, and data use Illinois Summary Performance Scores for EPHS 5 Overall, Illinois scored 23 (not met) on EPHS 5. This service is ranked 10 th among the 10 essential services. Performance Score by Model Standard for EPHS 5 80 >80 points 5.1 Planning and Implementation: Partially met Fully Met points 5.2 Technical Assistance and Support: Not met Substantially Met points Partially Met 5.3 Evaluation and Quality Improvement: Not met 5.4 Resources: Partially met <25 points Not Met Model Standard From Silos to Systems: Assessing Illinois' Public Health System,

22 SPHS Performance and IDPH Contribution Toward EPHS 5 The Illinois SPHS collectively achieves the following: percent of the Planning and Implementation model standard with 50 percent of the system s effort contributed by IDPH percent of the Technical Assistance and Support model standard with 75 percent of the 50 system s effort contributed by IDPH percent of the Evaluation and Quality 25 Improvement model standard with 50 percent of the system s effort contributed by IDPH percent of the Resources model standard with 50 percent of the system s effort contributed Model Stan dar d by IDPH Collective System Performance IDPH Contribution 100 Key Measures The three highest scoring measures for EPHS 5 The state public health system -- Conducts policy development activities; Uses workforce expertise in health policy; and Uses workforce expertise in strategic, long-range and operational planning. The three lowest scoring measures for EPHS 5 The state public health system -- Reviews progress towards accomplishing statewide health improvement; Provides technical assistance to integrate health issues and strategies into local community development plans; and Periodically reviews policy impact. Participant Observations Planning occurs in the public health system within individual organizations with few examples of broad collaborations. The Illinois Public Health Futures Institute is the first example of collaboration across issues. The concept of partners and of what is included in public health needs more attention. Planning for health is occurring at the local level, but not necessarily through partnerships. Planning is difficult when there s no money for implementation. Agency budgets make systems planning difficult. The appropriate partners that need to be involved in systems planning change rapidly. On the other hand, resource limitations and budgetary constraints can cause people to collaborate. Legislators and community leaders have a huge impact on the health planning process. Constituent populations do not. From Silos to Systems: Assessing Illinois' Public Health System,

23 IPLAN has stimulated community partnerships and local planning. However, technical assistance to local planning has been largely categorically focused; overall coordination of technical assistance has been compromised by inadequate staffing at the state level. From Silos to Systems: Assessing Illinois' Public Health System,

24 From Silos to Systems: Assessing Illinois' Public Health System,

25 Essential Public Health Service 6 Enforce Laws and Regulations that Protect Health and Ensure Safety This service includes -- The review, evaluation and revision of laws and regulations designed to protect health and safety to assure that they reflect current scientific knowledge and best practices for achieving compliance; Education of persons and entities obligated to obey or to enforce laws and regulations designed to protect health and safety in order to encourage compliance; Enforcement activities in areas of public health concern, including, but not limited to, the protection of drinking water; enforcement of clean air standards; regulation of care provided in health care facilities and programs; re-inspection of workplaces following safety violations; review of new drug, biological, and medical device applications, enforcement of laws governing the sale of alcohol and tobacco to minors, seat belt and child safety seat usage; and childhood immunizations. Model Standards Summary 6.1 Planning and Implementation Conduct enforcement activities based on current science by -- Reviewing laws and regulations to assure current scientific knowledge Soliciting input on existing and proposed laws and regulations Encouraging compliance through education and collaboration with those being regulated Establishing clear guidelines for enforcing laws Ensuring customer-centered administrative processes 6.2 Technical Assistance and Support Assist locals and other state partners by -- Providing protocols, consultation and training on enforcement practices Providing direct assistance for difficult enforcement operations Assisting local governing bodies in developing laws, regulations and ordinances 6.3 Evaluation and Quality Improvement Periodically review and improve enforcement activities by -- Reviewing enforcement workforce, technical assistance and administrative processes Monitoring procedures and actions to correct abuse or misuse Using review results to improve enforcement practices 6.4 Resources Manage resources to conduct enforcement activities by -- Allocating resources to areas of highest need and seeking new resources Leveraging system-wide resources Using expertise in legislative and regulatory development processes Using health education and enforcement expertise to strengthen compliance Illinois Summary Performance Scores for EPHS 6 Overall, Illinois scored 32 (partially met) on EPHS 6. This service is ranked third among the 10 essential services. Performance Score by Model Standard for EPHS 6 >80 points Fully Met 6.1 Planning and Implementation: Partially met points Substantially Met 6.2 Technical Assistance and Support: Not met points Partially Met <25 points Not Met 6.3 Evaluation and Quality Improvement: Partially met 6.4 Resources: Partially met Model Standard From Silos to Systems: Assessing Illinois' Public Health System,

26 SPHS Performance and IDPH Contribution Toward EPHS 6 The Illinois SPHS collectively achieves the following: percent of the Planning and Implementation 100 model standard with 50 percent of the system s effort contributed by IDPH percent of the Technical Assistance and Support model standard with 75 percent of the system s effort contributed by IDPH percent of the Evaluation and Quality Improvement model standard with 75 percent of 25 the system s effort contributed by IDPH percent of the Resources model standard with 75 percent of the system s effort contributed by IDPH Model Standard Collective System Performance IDPH Contribution Key Measures The three highest scoring measures for EPHS 6 The state public health system -- Monitors enforcement procedures to assure for professional conduct of personnel; Uses written guidelines to administer public health enforcement activities; and Uses workforce expertise to enforce public health laws and regulations. The three lowest scoring measures for EPHS 6 The state public health system -- Shares system-wide resources to implement enforcement activities; Reviews technical assistance provided to local public health systems and state partners regarding enforcement; and Makes improvements in enforcement activities based on review of findings. Participant Observations Interest groups with narrow agendas often drive the review of laws. Legislative policies are often not based on science. Despite continuous evolution of regulations to incorporate new knowledge, some regulations governing enforcement activities lag well behind current scientific knowledge. Inadequate funding for enforcement can compromise the safety of Illinoisans. From a resource perspective, assisting a regulated entity to comply is more difficult to justify than inspections. IDPH relies on delegate agencies and local partners for the provision of technical assistance and support in the environmental health area. They can only be as effective as the tools given to them by IDPH. Technical assistance is a big part of the grant process throughout the system. The tension between regulation and technical assistance needs to be examined. Administrators of regulatory programs are not allowed to provide technical assistance. From Silos to Systems: Assessing Illinois' Public Health System,